When we think of hospitals, we think of the life-saving doctors, nurses, and staff who protect and care for us in times of desperate need. Those frontline professionals represent the best of American medicine. Unfortunately, they are increasingly trapped inside corporate hospital systems whose financial incentives contaminate the provider/patient relationship.
President Trump deserves credit for once again putting a spotlight on a core problem in American healthcare: a complete lack of transparency. For too long, patients have been kept in the dark about what care actually costs and why prices vary so wildly. Transparency is not a partisan issue—it is a basic prerequisite for accountability.
Hospital systems and their associated financiers have taken advantage of regulatory loopholes and government distortions to price-gouge healthcare recipients for decades. From 2000 to 2022, hospital service costs skyrocketed by over 220 percent. That number is even higher today.
Hospitals are the price-setters in healthcare, and they are the first domino driving costs throughout the system. What’s worse is that many hospitals have built business models around staying one step ahead of policymakers, exploiting weak oversight and poorly enforced rules. As a result, patients pay more and get less.
This is why President Trump’s renewed focus on hospital transparency matters. Hospital billing remains opaque by design, making it nearly impossible for patients, employers, and insurers to shop for care or hold providers accountable. Urgent action is needed to force real transparency into hospital pricing, billing practices, and contracting. Without it, costs will continue to spiral.
Thankfully, Congress also has an opportunity to act. Upcoming House hearings on healthcare affordability should focus squarely on consolidation, market manipulation, and regulatory capture that undermine consumer choice. Without meaningful reform, public frustration with the cost of care will only grow. The Centers for Medicare and Medicaid Services project that, without congressional intervention, national yearly healthcare expenditures will reach $7.7 trillion by 2032, more than 60% higher than already unaffordable 2023 levels.
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America does not suffer from too much free market in healthcare; it suffers from too little. Hospitals’ monopolization of local markets, abuse of non-profit privileges, and resistance to transparency have helped make U.S. healthcare one of the most expensive systems in the world. In fact, the average cost of healthcare per person is twice as high in the United States as in other wealthy countries. These corporations are tactfully consolidating, creating horizontal monopolies that drive up prices and reduce competition. This consolidation directly undermines the free market and gives hospitals unchecked pricing power. In 2022, the ten largest health systems accounted for 22 percent of all non-federal general acute care hospital beds.
Despite transparency rules put in place during President Trump’s first term—and despite laws already on the books—many hospitals still refuse to comply. Enforcement has been weak, penalties have been minimal, and consolidation has faced little scrutiny. As hospitals grow larger, their ability to dictate prices only increases.
Nearly half of the nation’s hospitals operate under non-profit, charity status, shielding them from federal, state, and local taxes. This favorable treatment does not align with how many of these systems actually operate. For every $100 of incurred expenses, non-profit hospitals spent just $2.30 on charity care. By comparison, for-profit hospitals spent $3.80, a 65 percent increase.
Not only do they limit charity care, but they also actively avoid it. In New York City, only 36 percent of calls to advertised Medicaid providers resulted in an appointment. Hospitals routinely steer away from Medicaid, uninsured, and underinsured patients because lower reimbursement rates conflict with revenue targets.
To measure the gap between tax benefits and community investment, analysts use the “fair share deficit”—the difference between what hospitals receive and what they return. According to the Lown Hospital Index, that deficit reached $25.7 billion nationwide in 2021 alone. That is money taxpayers effectively subsidized without seeing the promised public benefit.
Today’s hospital systems increasingly resemble financial enterprises that happen to own medical facilities. They have learned that opaque pricing, limited competition, and weak oversight allow them to inflate costs without consequence. This money does not flow to frontline caregivers, and it certainly does not reach patients.
The bottom line is simple: you cannot truly address healthcare costs without confronting the actual cost drivers. Transparency is a critical first step—but it is not enough on its own. Congress must also address hospital consolidation, enforce compliance with transparency laws, and ensure non-profit status is not being abused.
It is time to restore accountability, competition, and transparency to American healthcare. President Trump is right to focus on transparency, and Congress should build on that momentum—not protect entrenched hospital interests. Hospitals exist to care for patients, not to game the system. Refocusing them on that mission is long overdue.
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